Methodical Instruction

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Methodical Instructions

For individual work of students in preparation for practical classes




Pathology of the visual and olfactory analyzers. Syndromes of the oculomotor nerves affection.





  1. Topicality: This topic is both important and hard part of neurology for learning. Pathology of the cranial nerves is met in numerous diseases.

Anisocoria is observed in different diseases: craniocerebral trauma, hemorrhagic stroke, brain tumors, subarachnoid hemorrhages, somatic pathology, tuberculosis of the lungs, aortic aneurysm, oesophagus tumors, stomach ulcer, liver diseases etc. A pupil of the eye usually change in neurosyphilis .

The change of the pupillary test can be revealed as Argyle-Robertson’s symptom in tabes dorsalis and ‘back’ Argyle-Robertson’s symptom can be revealed in epidemic encephalitis and treatment with great doses of neuroleptic. Strabismus and diplopia are the early stage of the pathological process at the base, in the region of the brainstem. Revealing of the oculomotor abnormalities has a great significance for the early diagnostics of tuberculous and syphilitic meningitis. Pupillary reactions and the pupil state can be a possible diagnostic indicator in the state of coma. Mydriasis is observed in mushroom poisoning, botulism, hepatic coma, etc. Miosis happens in uremic coma, alcoholic intoxication, morphine medications poisoning. Therefore every doctor must be able to identify the pathological changes of the oculomotor nerves and send patients to the proper specialist in time. Taking into account it every doctor has to know the symptoms of affection of cerebral nerves.

Specific purposes:

  • To know anatomy and physiology of the visual and olfactory analyzers.

  • To be able to diagnose smell abnormality

  • To be able to estimate changes of the eye grounds.

  • To be able to differentiate different kinds of hemianopsia

  • To know the localization of the nuclei of the oculomotor nerves in the stembrain, their significance, methods of their examination.

  • To know the clinical picture of the alternating Weber's syndrome, Benedict's syndrome, Foville's syndrome, Bernar and Horner's syndrome, Argyll Robertson syndrom

  • To be able to identify localization of the pathological process, to make topical diagnose.

  1. Basic knowledge, skills and competences which are necessary for topic studying:

Names of the previous subjects

Received skills


General anatomy

To know anatomy of the brainstem, lower surface of the brain, the structure of the precranial fossa, middle cranial fossa, posterior cranial fossa, the place of outlet of the cranial nerves.


General physiology

To know physiological of the I, II, III, IV, VI pair of the cranial nerves


Topographical anatomy

To know topography of the I, II, III, IV, VI pairs of cranial nerves and anatomical formations, situated behind their course

  1. Assignments for individual work during preparation for the classes

  2. а) The list of the basic terms, characteristics which students must learn during the preparation for the classes:

  • olfactory tracts

  • Anosmia, hyposmia

  • Optic tract

  • Optic chiasm

  • Homonymous and heteronymous hemianopsia

  • Photopsy

  • Stagnant papilla, optic atrophy

  • Ptosis, strabismus, mydriasis

  • Exophthalmos, enophthalmos

  • Accommodation and convergence

  • Diplopia

  • Argyll Robertson syndrom

  • Ophthalmoplegia

б) The list of theoretical questions:

1. Anatomy and physiology of the visual and olfactory analyzers

2. Visual analyzer tract

3. Anatomy and physiology of oculomotor nerves, localization of their nuclei in brainstem

4. Diagnostics of the homonymous hemianopsia evoked by lesion of optic tract and cortical hemianopsia

5. The clinical picture of the alternating Bernar and Horner's syndrome, Benedict's syndrome, Foville's syndrome

6. The clinical picture of Bernar and Horner's syndrome, Argyll Robertson syndrom

7. Kinds of strabismus
в) The list of the necessary practical skills that are to be mastered at the classes :

1. Examination of smell and taste

2. Examination of the visual acuity, fields of vision, color perception

3. Pupil’s reaction to light, accommodation and convergence

4. Examination of the oculomotor nerves function (manifestations of ptosis, strabismus, exophthalmos or enophthalmos, diplopia)

5. Examination of the movements of the eyeball

Curriculum of student individual preparation:

  1. To learn theoretical questions of the topic 8 (see the list of theoretical questions and sources)

  2. To know the methods of examination of the patients with hereditary-degenerative diseases of the nervous system.

  3. To acquaint with the tests and situational tasks and know right answers (collection of the tests and tasks, part “Cranial nerves”)

Material for self-control.

  1. To acquaint with the tests and situational tasks and know right answers(collection of the tests and tasks - module 1, topical module 2, part “Cranial nerves”)

Information sources:

  1. Shcrobot S.I., Hara I.I. Neurology in lecture (Selected lectures) . Ternopil, TSMU, «Ukrmedknyha», 2008. 319 p.

  2. Reinhard Rohkamm. Color Atlas of Neurology © 2004 Thieme. 440 p.

  3. Crash course Neurology by Anish Bahra and Katia Cikurel. Copyright 2006, Elsevier, Inc. 244 p.

  4. Adams and Victors. Principles of neurology. © 2005 McGraw-Hill . Medical Publishing Division.

  5. Mayo Clinic Internal Medicine Review 2006-2007. Chapter 18. Editor-in-Chief Thomas M. Habermann, MD

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